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Dear Doctors IN BC,
We've just finished one election that will have a monumental impact on health care. Now it's time for you to participate in another, for Doctors of BC.
I'm asking you to again consider your choices carefully. Ask yourself if the "collaborative" approach DoBC has taken with government—less confrontational, partnering to the extent of 2/3 of operating funding coming from government— and DoBC staffing (and fees) rising has been effective for you and your patients.
Influence? How much influence has DoBC really had?
Consider what the government has pushed through in recent years:
Effective? Arguably DoBC's signature recent accomplishment, LFP only came about due to pressure from grassroots community patients groups, supported by grassroots physician groups. And yet, having once-in-a-generation leverage, DoBC fell for obvious negotiating tactics to come up with a deal that still:
This was a minimally viable policy that kept ~1000 family physicians from leaving, but didn't come close to fixing the problems in family practice.
An Opportunity. We have a new government starting with few concrete ideas on healthcare. While less obsessed with centralizing control and marginalizing professionals than their predecessors, they're likely to put forward ideas that are just as damaging, albeit differently. Now is the time where a strong physician voice is needed.
Vote for Accountability. I don't have a vote in this. But please consider voting for candidates who will push for DoBC to have a much stronger voice, and call out failures. Who will ensure joint projects like the JCC's are answerable to physicians. And where physicians' needs drive the organization staff, not vice versa.
I want to see leadership with a solid track record on accountability and governance reforms on behalf of physicians, not those who will be compliant with existing failed approaches.
Mark Roseman, Victoria, BC
October 29/2026
p.s. see https://markroseman.com/docs/ for previous commentary and far more details on these issues
p.p.s. please feel free to share in physician-only FB groups and other communities if you feel appropriate
But we need real leadership from physicians to make that a reality. And I think that's what lacking.
I don't think Doctors of BC has demonstrated the leadership necessary to effect real change.
In some ways, I think it's even contributing to the problem by not more prominently reflecting the values of front-line physicians. They're fighting daily for their patients' interests in what has become a dysfunctional system. I've heard from too many physicians who are frustrated with DoBC and at the same time afraid to speak publicly for fear of retribution.
We need honest talk about the health system. In my opinion, we're not getting enough of that from DoBC.
This page is a way for me to share my personal understanding of what's happening, why it's happening, and what doctors can do about it if they want to see things change.
I expect many will disagree. That's good. The conversation needs to happen. We all lose if it doesn't.
OCT 31: I don't know a single MD who's volunteered their time on boards, committees, etc. who hasn't done so because they want to see things improve. They do so despite overwhelming personal, family, and patient care commitments. It's a big sacrifice. They all deserve thanks.
These orgs mostly rely on paid staff to function—docs don't have the time (or often the skills). So MDs are (rightly) in advisory, oversight, and leadership positions. They're there to set priorities, goals, strategy, and direction, which they delegate to the staff to implement.
But effective staff oversight is hard work. It definitely does not just happen. Governance and accountability take a lot of both various skills and experience. Which is why you see senior people from a wide variety of backgrounds on successful corporate or non-profit boards.
Most MDs who volunteer, because of the intense demands of their profession, haven't always had the opportunity to obtain those skills and experience. Which makes their role (effective oversight, governance, and accountability) far more challenging. It's a steep learning curve.
There are well-known ways for organizations to deal with this, involving training, mentorship, and other "onboarding" for new members. And also measuring board effectiveness, operations, culture, etc. through engagement and governance surveys or other means.
These are critical for orgs who have frequent turnover in their advisory and oversight boards, where you have a large number of "fresh" volunteers on their boards.
Otherwise you can end up in a situation where the leaders aren't managing the staff.
Instead, the staff are managing the leaders.
I don't have any answers, and I definitely don't have the qualifications or ability to fully grasp what MDs need (I'm just another person volunteering my time because I want to see things improve).
I think asking the questions and discussing them is important. Out in the open.
(written Oct 20/2024, the day after BC's election)
Dear Doctors IN BC,
However this mess gets sorted out, one result is crystal clear.
Politicians won't save the health system from the growing crisis.
If your patients, your values, and the profession you've dedicated your life to mean anything, it's up to you.
You all know exactly how bad things are on the front lines, and how much worse they're likely to get.
You also know (more or less) what a functioning system would look like. And that for it to work, physicians need to have a real leadership role in delivering care.
We've got two political outcomes.
The first is more of the same, billions more spent on bureaucracy, marginalizing and silencing dissent, and destroying your autonomy. In this world, you're cogs, subservient to ignorance and self-serving grifters. This is your calling? [1]
In the other outcome, you're (at best) facing a world dominated by fast-food medicine, increasing Telus-ization and Well-ization, driven by an anti-science brigade of hooligans. At the expense of you and your most vulnerable patients. Think moral distress is bad now?
I don't know any of you who would cheer either scenario. But I don't know that anything could have changed where we are today.
Politics failed patients. Politics failed healthcare. Politics failed you.
So what are you going to do about it?
In this campaign, both sides told ridiculous lies about what's happening and what they could do to fix it.
You can't change that. But you can change how you RESPOND to it.
Because frankly, I can't imagine many of you are happy with how physicians as a group did respond.
The lies were virtually unchallenged. [2] Reality took a back seat. Does this strike you as standing up for patients' best interests?
Physicians as a group have tremendous power. But it hasn't been used. Think about what's happened in the past few years.
An exploding bureaucracy drives your daily lives. Idiocies like UPCCs drain funds away from real care. No accountability for results in the system. A step forward for FPs, yes, but not sufficient to maintain a sustainable practice, with no political capital left.
It's been 10 years since DoBC adopted this "collaborative" approach. I think it's time to look at whether it's working. Whether the health system is better off. Whether you're more satisfied in your careers.
In that time, DoBC grew tremendously. But mostly on various "joint" projects with govt, funded by govt. The idea being that doctors are at the table for key decisions about the direction of health care.
Does it feel like doctors have real sway there? Or are pawns?
In that time, membership revenues went from > 60% of DoBC operating funds to < 30%.
Do you think that's changed their priorities?
Are they working as effectively for you?
Or do they now have more competing interests?
I won't re-litigate it, but while LFP was an important step forward, it cost too much. Watching from the side, you could see the govt's negotiating strategy wiping the floor with docs to get what they wanted. Why didn't docs have professional negotiators in the room too?
Do you want to continue like you have been?
Or do you want to take a stand for effective public health care? For truth and accountability? For smart spending? For knowledge and expertise?
You're seeing doctors in Alberta speak out for truth and for patients in the face of their dysfunctional govt's attack on healthcare. Quite the contrast to here.
They may not win, but they'll see themselves in the mirror afterwards and be proud of what they stood for.
You've got your own election coming up, for DoBC president, who speaks for you and your values. Also several members of the RA, board, and committees.
I hope some people step up who when they hear "better together" they think doctors and patients.
It is time for change.
Mark Roseman, Victoria, BC
October 20/2024
NOV 5: Virtually everyone who runs for DoBC leadership touts the "better together" (united as a profession and with government) slogan, and highlights their own collaborative skills and accomplishments in these relationships. As they should. It's important.
But I also think we need to look at the evidence. Because frankly, we've all had more than enough of communications and messaging that is easily confused with one-sided marketing of a single position rather than objectively laying out the facts and the range of options.
Was what you heard about LFP the full story?
I said I wouldn't re-litigate LFP, as I've written to death about it already. But it's surprisingly illustrative of how DoBC has operated and what the (hidden) costs have been. And yes, for longitudinal FPs, this is a massive improvement over what came before, no question. But as good as it was sold? And at what cost?
Let's remember the context. Govt was on the hot seat about family doc compensation, put there not be DoBC but by BCHCM. In the public mind, govt was firmly on the hook if they didn't come up with a winner. For DoBC, a once-in-a-generation bargaining opportunity.
Instead, through what were obvious (to me) negotiating tactics, govt manipulated DoBC so that the weight of delivering a good deal (and not failing) shifted from them to DoBC. They were the ones who now needed a deal or would suffer the consequences. They even spelled out in public what would be required to call a deal successful. Not a ceiling (ask) for the negotiations, but a floor. I wasn't there, but I have trouble believing this would have happened if there were skilled and experienced (non-physician) negotiators in the room.
Advocates or cheerleaders?
DoBC was also manipulated into being full-fledge cheerleaders after the deal (pretty much the minimum acceptable by their criteria) was concluded. They didn't talk about how they had to compromise, or were pleased but had reservations, etc. No, they sold it to membership and the public. Hard. What was the take away? FPs in BC now make at least $385k (forget overhead). They're now the best paid in the country. This will save family medicine. It did prevent it from going off the cliff it was headed for, but hardly saved it. And they continue to sell it to this day.
What effect do you think that has on your future negotiating position?
They had a terrific negotiating position. Gave it away. It cost a ton of leverage and political capital. But let's be honest about what LFP provides for. Salary replacement for a FP. Not enough to cover overhead. Not enough to support physician-led team-based care. Maintaining a successful practice and being paid what you deserve still requires begging the government for money, at a tremendous cost to physician autonomy. It provides a base billable hourly rate equivalent to a paralegal (a two-year program). Better than before? Absolutely. What you're worth? Far from it.
Nobody in DoBC is talking about these things. Because they're too focused on playing nice publicly. (I have no idea what's going on behind the scenes.)
UPCCs? HPOA? Scope creep? JCC's?
Some other examples? Expansion of dysfunctional UPCC's instead of independent practices. Scope creep of pharmacists and other professions into primary care. The provisions in the new HPOA restricting your ability to speak out or practice independently. Gag orders in health authorities.
And don't forget large chunks of discretionary funding as the result of "joint" projects between government and DoBC. Projects that by the way now make up a larger portion of DoBC's expenditures than anything they do to advocate for physicians directly. Who's driving this? Is it meeting your needs? Are the JCC's even accountable to the elected physician leadership of DoBC (board, RA)? Because I'm not seeing it.
Remember, funding for the JCC's was negotiated by DoBC as part of recent PMA's, so that physicians have a voice in these decisions. And DoBC didn't get these things for free. Their "gains" in that part of the PMA came at the expense of other things, like more direct accountable physician funding (i.e., money for your practice). Was it worth it? How would we know?
Govt gives the impression of how it's working together with doctors, but is it? Everyone says so, but where's the evidence?
So what about DoBC leadership?
DoBC leadership candidates talk about their experience getting results by working together with government. "Government listens to a unified [and collaborative] DoBC." But does it really? It's hard to assess these results if all you're seeing is tightly scripted one-sided communications about how great things are going. You deserve better than this.
Who's making sure that the growing bureaucracy in DoBC is accountable to physicians?
We're all in need of some honest talk about the health system, and in my opinion, we're just not seeing that now from DoBC.
Ask yourself, will the people you put forward for leadership articulate your values and priorities and protect your dwindling autonomy, or will they be enveloped by the PR machine that DoBC appears from the outside to be?
Being strong does not mean being confrontational, aggressive, or unhinged. You can be assertive and effective without being all those things.
If DoBC, the organization that speaks for doctors, isn't standing up for honest conversations and evidence, who is?
Yes, of the candidates running for DoBC president, I think Dr. Gandhi is far and away the most likely to ensure that DoBC speaks up for physicians values and fighting to ensure there is evidence things are "better." He's obviously fought for these things before, most notably with the health authorities, which I think most physicians agree are not as effective or transparent as they should be. He's also spent enough time in advocacy and politics to better appreciate what works and doesn't when it comes to effecting change in complex relationships like we have in healthcare.
I also know he's sought out (and has been getting an earful) about the issues facing family medicine. I'm confident he deeply appreciates that family medicine is at the most risk right now when it comes to physician independence and autonomy.
I don't know as much about the other three candidates. From their CV's, they've spent enough time enmeshed in DoBC to have a good feel for how things work. I'm not convinced they'd be effective at ensuring accountability and evidence for results and that the real physician voice is heard.
[1] I just want to amplify this point a bit. Because I still have huge concerns with how weak real opposition has been regarding these things.
To to my mind, they constitute an existential threat to all physicians.
BC's Health Professions and Occupations Act (HPOA) is effectively a government takeover of CPSBC and other regulatory colleges. Board fully appointed by govt. Draconian provisions allowing MOH to micromanage physician behaviour and punish dissent.
It's been bad enough with the health authorities punishing physicians who don't toe the line. Many have had their careers destroyed if they didn't comply.
Doctors who are gagged and kept from speaking out on behalf of their patients—it's wrong.
Many have no choice but to work under HA control (e.g., they need hospital facilities). But many have had other options, e.g., private practice. Politicians threatening their licenses means every BC doctor is now at risk from speaking out.
The response to HPOA has been underwhelming to say the least.
And then there's the growth of administration and bureaucracy, directly impacting physician autonomy and undermining their ability to work on behalf of patients. (Stay tuned AB—this is where you're heading!)
Since the NDP took power in 2017, centralized bureaucracy ("corporate" expenses in the massively expanding health authorities) has grown from $1.4B to $3.5B per year (11.5% of total health budget).
I've compiled the details at takingaction.ca/corporate.
Not only is that an extra $2.1B of "health money" that could be better used elsewhere to provide care, but much of that bureaucracy is creating the policies, paperwork, and gross systemic inefficiencies that undermine efficient physician practice.
Again, the response from physician's groups (beyond "too much paperwork") has been underwhelming. This is where the false, divide-and-conquer "team-based" care, sole-source Telus contracts, devaluing and deskilling of MDs, and zero accountability is rooted.
Govt and HAs have very good reason to hide and not draw attention to the details of this. Their focus on communications over patient outcomes and wellbeing is repugnant but understandable. But physicians?
It's pretty clear why individual physicians, or at least those still part of the system, are scared to speak out. Their livelihoods are at great risk.
But for the organizations representing them as a group to stay silent?
Having said all that, I'm not against collaborative or "soft power" approaches to problems, which is the approach DoBC has taken.
But at some point you have to step back and ask if it's been effective, or if a change of tack is warranted.
I think that time is now.
[2] The NDP told some ridiculous lies about how many patients are attached to family doctors. They used DoBC to back up their phony numbers. DoBC stayed silent. Think that impacts your credibility?
To recap, the NDP claimed that 88% of people in BC have a family doctor. Where did this ludicrous number come from? An election priorities document from DoBC said "more than 700,000 patients are still without a family doctor in BC." So 700k is ~12% of BC's ~5.5M population, ergo 88% have a family doctor. And they explicitly said DoBC was a source for this claim.
To spell it out, DoBC's number was clearly a very conservative estimate. It's not based on real data, because the government doesn't make real data available. They were justifiably worried they'd be challenged if they said it was more (since they couldn't prove otherwise). So they said at least 700k. The NDP took that and turned it into only 700k and extrapolated from there.
Response from DoBC to this gross misuse of its claims? Nothing. What's the public going to think? DoBC was a source for this after all.
Following this there were a series of games about how many people have been attached to primary care (248k since 2023, 570k since 2018). This and some other funny math was used to claim by the end of the campaign that by the end of 2025 everyone would have a FP/NP. We all know this isn't remotely possible.
If you're curious, one of the main tricks they used to justify these wild numbers was they've only ever talked about the number of patients who've been attached to family doctors, not those unattached, as people move, retire, practices close, and all the usual churn. People never lose their doctors, right?
In one of the NDP press releases about their miraculous attachment numbers, there's a quote from Dr. Karimuddin on behalf of DoBC. If you read it closely, it only says that, in effect, 'more primary care would be good.' But most of the public sees and hears this and reasonably concludes that DoBC is in agreement with the claims made about attachment.
Again, no response from DoBC. If you're standing up for your patients, standing up for evidence and accountability, how could DoBC have stayed silent?
OCT 28: Every MD in BC should read this opinion piece by Dr. Ahmer Karimuddin (DoBC president) on physician voice, change, and mutual understanding. Talks about seeing things from different perspectives, listening, giving everyone a space to share, change through incremental progress and feedback.
Lots I agree with. To me, it's also an accurate reflection of DoBC's external stance (perhaps less so it's internal one).
BUT.
It presumes shared values. Do physicians and government share the same values? Some of them yes, but some of them no. If there are differences in values, do we openly and honestly discuss them? Or bury them away, because they might hurt one side or another? Is disagreement or dissent tolerated?
What of the role of power? Of control? Compromise and win-win is great if everyone is playing the same game. Are they? Have we had enough of small-scale incremental experiments to try to "persuade?" Good results don't always win. How many times have we seen one side bulldoze through what they wanted, effectiveness be damned?
Psychological safety, seeing things from different perspectives, listening, and giving everyone a space to share are great. That's the environment we should have. But is it the one we do do have? More words. Do the actions match? Idealistic? Naive? Maybe. But effective?
Also, do you feel that other powers in the health system are taking the same approach? Providing a psychologically safe space for dissent? Moving forward with experiments and then iterating based on their results, rather than immediately pushing through widespread change?
Doctors (as a group) do themselves a disservice when they don't show themselves as honest arbiters of truth about how the health system is functioning. Including calling out (professionally) lies. It undermines public confidence and trust. Which is already tumbling downhill. Should this be sacrificed in the name of "collaboration" or "better together"?
Most docs see themselves (mostly but not always accurately) as driven by public good and evidence. That is (should be) your "brand." When docs' groups stay silent in the face of blatant lies about system issues (and propaganda) that impacts patients, it undermines that brand. It's also a very significant contributing factor to the moral distress of your members. What do members want your group to stand for?
Let's face it, when MDs play the politics game (strategy, negotiations, communications) against politicians, politicians win every time.
Docs should ask themselves… has this strategy paid off? Does it reflect your values?
Do physicians on the RA, committees, or broader membership feel your voice is being heard? Or that you're being stage-managed to provide the illusion of input?
How effective has the physician voice been in having real influence? Or has it been as effective as the patient voice in health system decision making… token involvement for appearance's sake, but mostly ignored?
Any physicians on the board, RA, committees, or broader membership care to offer a reponse or counterpoint to Dr. K's piece? Would you feel safe to do so? (If answer to the latter is "no", please email me and I can share).
OCT 31: Reflecting further on Ahmer's BCMJ editorial (original comments above), I think it's indicative of an accountability and governance crisis within the organization.
Are MDs driving DoBC?
Or staff and external stakeholders (i.e., govt)?
Are MDs there for appearance's sake?
Do the board/RA work for staff, or the staff for them?
Whose concerns are heard, whose are ignored?
Is internal and external communication scripted, or is there open, informed, and authentic discussion on priorities?
Who is making the decisions?
Did Ahmer initiate and write that "stay in your lane" editorial? To be honest, it doesn't seem like the views of any of the physicians I know are reflected in DoBC's public statements and priorities.
Is the DoBC president a figurehead who is there just to spew PR?
Technically, as I understand it, the RA oversees the board who handles most of the strategic decisions and oversees the (ever-growing) staff who implement policy and deal with day-to-day. Is that what's happening?
Or is the staff stage-managing and controlling the board/RA?
Open communication? I've heard that members of the RA do not even have each others' full contact info. So they're discouraged from speaking outside of formal scripted meetings, organizing, or sharing concerns. Requests to staff to distribute that info were rebuffed. That's not healthy.
Oversight? Does the board and RA assess the performance of senior staff, committees, JCC's, etc.? Financial oversight?
Are there clear, objective, verifiable performance metrics? Do they reflect the board and RA priorities? Are real questions asked? Or is it one big dog-and-pony show?
Ask the hard questions.
I'm not here to lay blame, because I think everyone is probably doing what they think is right. But it's way past time to be asking some hard questions about if doctors are in control of DoBC. Starting in the RA.
Because as we've seen with CPSBC, control can disappear quickly. DoBC has (or should have) a big impact on the health system. At times, it even represents itself as a proxy for patients' interests. Is it effective?
The structure of DoBC gives docs control of the organization.
But only if they use it.
While they still can.